Insurance issues may put Groton teacher's kidney transplant on hold

Mystic — After an eight-month search to find a kidney, Groton teacher Brad Vernet was finally slated to undergo a transplant at Brigham and Women's Hospital in Boston on April 10.

But now he may have to delay that surgery and face the prospect of going on dialysis after his insurance company told him last week he is not fully covered for the procedure because the hospital is not in his insurance network. This means he could face a bill of as much as $100,000.

The news came as a shock to Vernet and his wife Katy, who say the hospital told them last summer the transplant would be fully covered.

"I was in total disbelief, " Vernet said today about the call he received from Anthem Blue Cross/Blue Shield telling him it would only pay 80 percent of the bill.

"I've got this overwhelming joy and gratitude associated with finding a donor and then it's just pulled out from under you," he said.

Vernet, who is slated to go to Boston on Friday for his pre-op testing and appointments, said he may now have to delay the surgery and move it to another hospital that is in his network, something he said he would have done earlier if the hospital had not assured him he was fully covered.

Delaying the transplant may now put him in the position of having to go on dialysis, as his kidney function has dropped to just 8 percent.

Vernet has taken a leave from work to preserve his kidney function as long as possible and hopefully avoid going on dialysis before surgery. The long days in the classroom left him exhausted and put more stress on his kidney.

Vernet said he does not think he can go ahead and incur the out-of-pocket costs, especially with his two children approaching college age.

If he did proceed, he would have to agree to pay whatever the out-of-pocket costs would be. The bill could escalate beyond the $50,000 to $100,000 if there were complications or a longer-than-expected hospital stay.

The Vernets, who live in Mystic, said that last July they received a letter from the hospital saying they were "adequately covered" for the surgery. When they questioned the financial counselor for transplant surgery about what that meant, they said they were told that meant there was 100 percent coverage.

"If they had said 'you're out of network,' we would have went to the Lahey Clinic which is just down the road," and in network, said Katy Vernet, a teacher at Claude Chester School in Groton.

She said the hospital and insurance company are blaming each other for the problem and the hospital has filed a grievance with Anthem.

"We really don't know who dropped the ball," she said. "Everything had been put in place but now were in complete limbo. No one is calling us back."

The Vernets have contacted both the hospital and insurance company about the coverage, but so far, there has been no resolution. They have also contacted U.S. Sen. Richard Blumenthal, D-Conn., for help. The Vernets also plan to file a complaint with the state insurance commission.

Vernet's search for kidney drew widespread attention as his friends and family used Facebook and YouTube to find him a kidney before one of his former classmates from Springfield College was found to be a match.

Brigham and Women's spokeswoman Jessica Maki said today that the hospital is not allowed to discuss patient information unless a patient has given written permission to do so.

Anthem's Connecticut spokeswoman Sarah Yeager said customers have to sign a release in order for the company to discuss patient information.

Both the hospital and Anthem took steps late this afternoon to secure that permission and said they could discuss the situation once they did.

For Vernet, who teaches science at West Side Middle School, the experience has been an education.

"This is strange, because you realize how much of a business this is," he said.